Establishing the functional viability and dose-response of Duck, Duck Punch: A Stroke Rehabilitation Computer Game ABSTRACT Only 15% of stroke survivors experience full recovery of arm/hand movement. Long-term arm movement impairment restricts independence with self-care and vocational activities, increases caregiver burden and reduces quality of life. Strong evidence is emerging that traditional therapy programs do not provide adequate amounts of movement practice needed for motor recovery yet, current financial pressures increasingly limit stroke rehabilitation programs. Thus, there is a need for innovative technology to augment traditional programs to provide the necessary movement practice within the constraints of the current rehabilitation landscape. To meet this need, we developed a prototype Kinect-based post-stroke rehabilitation game called Duck Duck Punch (DDP). While maintaining the appeal of a game, DDP has a therapeutic focus because its unique design elicits an arm motor recovery process consistent with evidence-based stroke rehabilitation principles. The player moves his/her physical arm to control an avatar arm to reach and ?punch? virtual ducks. Custom features allow tailoring of the game so that patients' success requires ?therapist approved? healthy arm movements. Therapists can integrate DDP into in-clinic or in-home programs for additional quasi-supervised movement practice because a performance report quantifies and monitors progress toward motor recovery goals. We licensed DDP and formed a company, Recovr, which has received investment funding for initial start-up and market research. In a funded NIH/NIGMS CTR pilot project, we established the technical merit and feasibility of DDP as a tool to augment inpatient, outpatient and home-based stroke rehabilitation. Very promising results motivated the current project that seeks to test the functional viability of DDP and determine its commercial potential. In this project we propose to (1) evaluate whether home use of DDP for 6 weeks improves post-stroke arm motor ability; (2) examine the dose-response relationship by relating movement repetitions to arm motor skills; and (3) determine the treatment validity of the DDP report as a measure of impairment and response. We will enroll n=60 subjects with stroke to participate in a single blinded, parallel- arm study with blocked randomization according to arm impairment level to test the hypothesis that playing DDP facilitates improves arm motor skills more than playing a commercially available game. In addition stroke survivors (n=16), caregivers of stroke survivors (n=16) and stroke rehabilitation therapists (n=32) will participate in focus groups to guide further development of the DDP summary performance report in order to improve its validity for informing future treatment decisions. This project is important because there is a need to develop and market new options to extend post-stroke arm motor rehabilitation programs. This project will yield data regarding DDP's effect on recovery, dosing, and the translatability of its performance report. Thus, this Direct-to-Phase-II SBIR will set the stage for a future definitive study to enable clear decisions regarding the clinical utility and commercialization of DDP to therapists and stroke survivors.